Provider Demographics
NPI:1629152962
Name:CONKLIN, PHILIP DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:DANIEL
Last Name:CONKLIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15055 EAST FWY
Mailing Address - Street 2:SUITE C10
Mailing Address - City:CHANNELVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:77530-4144
Mailing Address - Country:US
Mailing Address - Phone:281-862-0800
Mailing Address - Fax:281-862-0835
Practice Address - Street 1:15055 EAST FWY
Practice Address - Street 2:SUITE C10
Practice Address - City:CHANNELVIEW
Practice Address - State:TX
Practice Address - Zip Code:77530-4144
Practice Address - Country:US
Practice Address - Phone:281-862-0800
Practice Address - Fax:281-862-0835
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6146111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX603870OtherINDIVIDUAL #
TX8X8730OtherBCBS
TX603870OtherINDIVIDUAL #
TXU41883Medicare UPIN
TX8085N0Medicare PIN